| NPI | 1225046139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 258) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-300) |
| 363A00000X Physician Assistant (Licence: MT 300) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-12-27 |